ObjectiveTo observe the effects of local mild hypothermia at different time on dopamine (DA) and 5-hydroxytryptamine (5-HT) concentration in rabbits brain basal ganglion with bilirubin encephalopathy. MethodsThe model of bilirubin encephalopathy was established, and treated with mild hypothermia for different time. The DA and 5-HT in the basal ganglion were detected with fluorescence spectrophotometry. ResultsThe DA and the 5-HT decreased in the basal ganglion significantly after modeling (P<0.01), and increased when treated for 6 h, 12 h or 24 h (P<0.01). ConclusionLocal mild hypothermia can significantly reduce the disorder of DA and 5-HT during bilirubin encephalopathy. The longer the hypothermia, the better the effect is.

OBJECTIVE:To observe clinical efficacy and safety of salmeterol fluticasone combined with tiotropium bromide in the treatment of COPD via different inhalation devices.METHODS:Eighty COPD patients were selected from our hospital during Jan.2014 to Jan.2015,and then divided into trial group and control group according to random number table,with 40 cases in each group.Both groups were given Salmeterol fluticasone inhalant 500 μg,bid+Tiotropium bromide inhalant 18 μg,qd.Control group was given medicine via inhalation device coming with medicine,while trial group was given medicine via gas compression type ultrasonic spray inhalator.Both groups were treated for 1 year.Blood concentration of medicine 0.5 h after medication,mMRC score and COPD acsessment test (CAT) score 3,6,9 months after treatment,the times of acute exacerbation during treatment,FEV1％ before and af ter treatment were all observed in 2 groups.The occurrence of ADR was recorded.RESULTS:Four cases withdrew from trial group and 1 case from control group.After medication,there was no statistical significance in blood concentration of fluticasone,salmeterol and tiotropium bromide between 2 groups (P＞0.05).0.5 h after medication,mMRC score of trial group was slightly lower than that of control group,without statistical significance (P＞0.05);CAT score of it was significantly lower than that of control group,with statistical significance (P＜0.05).The times of acute exacerbation in trial group during treatment was significantly less than control group,with statistical significance (P＜0.05).The decrease of FEV1％ in trial group was slightly lower than control group,without statistical significance (P＞0.05).The incidence of ADR in trial group was significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:For COPD patients,salmeterol fluticasone combined with tiotropium bromide via gas compression type ultrasonic spray inhalator is better than inhalation device coming with medicine in clinical efficacy and safety.

0.05). (2) There was a significant difference in the distribution frequency of ?_2-AR at locus +46 between mild, moderate and severe degrees of PIH (P

Objective To investigate the correlation between serum tumor markers levels with the disease condition activity and the tumor occurrence in the patients with rheumatoid arthritis(RA).Methods Serum tumor marker CA199,CA153 levels were de-tected in 35 patients with RA (RA group)and 31 healthy controls(normal control group).ESR and CRP were examined and the disease activity (DA)was assessed by the DAS28 score in the RA group.The serum tumor markers levels and the positive rates were compared between the RA group and the normal control group.The correlation between the serum tumor markers levels with ESR,CRP and DAS28 score was analyzed.Results Serum levels and positives rate of CA199,CA153 in the RA group were higher than those in the control group(P <0.05).The serum CA153 level had a positive correlation with the ESR,CRP and DAS28 score in the RA group(P <0.05),but the serum CA199 level had no significant correlation with them.Conclusion The serum levels and positive rates of CA199 and CA199 could be increased in the patients with RA,moreover the increase of serum CA153 level is corre-lated with DA of RA.Therefore the serum tumor marker CA153 level may be used as one of reference indexes for evaluating the DA in the patients with RA.

Objective To investigate the distribution pattern and antimicrobial resistance of the clinical isolates of pathogen.Methods The identification and dug susceptibility tests of the isolates from 2013 to 2015 were performed by using VITEK2-compact system.The susceptibilities of isolates to antimicrobial agents were analyzed with WHONET 5.6 software.Results A Total of 2 991(90.4%) gram-negative bacteria and 317(9.6%) gram-positive bacteria were isolated.Among all of the isolates,the top three pathogens were Klebsiella pneumonia,followed by Pseudomonas aeruginosa and Acinetobacter baumannii.The detection rates of extended-spectrum beta-lactamase(ESBLs)-producing Escherichia coli were 40.4%,48.2% and 38.3% respectively in the three consecutive years,while the detection rates of the ESBLs-producing Klebsiella pneumonia were 16.9%,8.4% and 11.6% respectively.No Escherichia coli resistant to impenem were detected.The resistant rate to impenem of Klebsiella pneumonia was 1.6%.The detection rates of methicillin resistant Staphylococcus aureus(MRSA) and methicillin resistant coagulase-negative staphylococci(MRCNS) in the three years were 53.8%,54.3%,42.9% and 84.5%,82.7%,85.9% respectively.No Staphylococci isolates resistant to linezolid and tigecycline were found.Enterococcus isolates were sensitive to gentamicine,linezolid,tigecycline and vancomycin.Conclusion Carbapenems could remain the best antimicrobials against Enterobacteriaccae.Lnezolid and tigecycline could be effective antimicrobials against Staphylococci isolates.The detection rates of Klebsiella pneumonia and Acinetobacter baumannii increased year by year.The monitoring of drug resistance should be strengthened to control the emergence and spread of multidrug resistant pathogen.

Objective To settle the "bottleneck" disputes existed in the key aspect of emergency treatment care of emergency department, long delayed time of medical workers or patients, perplexity of first-aid personnel, less standard in medical records. Methods Comparison experiment was carried out with the traditional model of emergency care in contrast with the new model, besides the service attitude was improved,the awareness of responsibility was strengthened and the first-aid technique was increased. Number of nursing errors and disputes, hospitalization time, satisfaction degree of patients and record trace-ability were observed. Results The nursing errors and disputes reduced by 46%, hospitalization time re-duced by an average of (7.2±0.2) minutes, satisfaction degree of patients increased by 10.99%, leaving 1673 record traceability of care. Conclusions The application of new management processes of nursing interface in emergency department can settle the "bottleneck" disputes of key interface, make the green passage of emergency patients more convenient and is conducive to safe care, less mortality, high work effi-ciency, which proves to be a reference for fellows.

BACKGROUND:At present, a great quantity of research has shown the effectiveness of traditional Chinese medicine and bone marrow mesenchymal stem cel s for vascular restenosis. However, studies concerning their combined application to restenosis after percutaneous transluminal angioplasty with diabetes mel itus are presently lacking.
OBJECTIVE:To observe the effects of combined application of bone marrow mesenchymal stem cel s and benefiting-Qi nourishing-Yin and dissolving-congestion prescription on restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus.
METHODS:A dog model of vascular restenosis with diabetes mel itus was established by bal oon injury of femoral artery and intravenous injection of al oxan. After successful model induction, 22 dog models were randomly divided into three groups:model group (n=6), treatment with Chinese medicine (n=8), and combined treatment with bone marrow mesenchymal stem cel s and Chinese medicine (n=8). Serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay preoperatively and at 1, 2, 4 and 8 weeks postoperation. Samples of vessels were taken to conduct pathomorphological observation and quantitative analysis of proliferation degree. Tissues, including heart, liver, kidney and pancreatic gland, were col ected to evaluate the safety of stem cel transplantation using hematoxylin-eosin staining at 8 weeks postoperation.
RESULTS AND CONCLUSION:Serum vascular endothelial growth factor levels began to increase at 1 week postoperation in the Chinese medicine group and combined treatment group, at 4 weeks postoperation in the model group compared with preoperation (P<0.05). At al time points, serum vascular endothelial growth factor levels were highest in the combined treatment group, but lowest in the model group (P<0.05). Quantitative analysis of vascular proliferation demonstrated that at 8 weeks postoperation, new intimal area, new intimal/medial areas and stenosis rate were highest in the model group, but lowest in the combined treatment group at 8 weeks postoperation (P<0.05). Safety assessment of stem cel transplantation showed morphological structures of the heart, liver, kidneys and pancreas were normal, no necrosis. In a word, the effects of the combined application of bone marrow mesenchymal stem cel s and benefiting-Qi nourishing-Yin and dissolving-congestion prescription were much pronounced in preventing restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus rather than single therapy of Chinese medicine. It is a safe and effective treatment to prevent vascular restenosis after percutaneous transluminal angioplasty in dogs with diabetes mel itus.

Objective:To investigate the knowledge level of hospice care and the related influencing factors among health providers in Shanghai.Methods:From November to December 2019,a questionnaire survey on the hospice care knowledge was conducted among 7 074 health providers from 223 registered hospice care clinics or institutions in 16 districts of Shanghai.Results:A total of 7 027 valid questionnaires were recovered, with an effective recovery rate of 99.3%. Among the 7 027 responders, there were 1 460 males (20.8%) and 5 567 females (79.2%) with an mean age of (36.9±9.3) years; 2 682 nurses (38.2%) and 2 442 doctors (34.8%); 5 065 (72.1%) from community health service centers; 2 982 (42.4%) involving in hospice care services and 4 039 (57.5%) willing to work in hospice care. The average score of hospice care knowledge was (8.9±2.6), and the average accuracy for questions was 59.0%. Health providers had the highest awareness rate for the composition of hospice care professional team (93.9%, 6 597/7 027) and the lowest awareness rate for the emotional commitment in hospice care service (16.6%, 1 165/7 027). Health providers with junior colleges degree ( B=-0.429), vocational college degree and below ( B=-0.544), nurses ( B=-0.652), working in suburban areas ( B=-0.278), social office ( B=-0.891), without witness of dying process of end-of-life patients ( B=-0.329), not involving in hospice care services ( B=-0.283), and not willing to participating in hospice care ( B=-0.820) had low knowledge scores ( P<0.05). Conclusions:The overall level of hospice care knowledge of health providers in Shanghai is generally at a medium level, and the training of hospice care knowledge should be strengthened for the better development of hospice care.

Objective:To investigate the current training needs of hospice care among health providers in Shanghai.Methods:Based on the B.S. Bloom classification of educational objectives,a questionnaire on the training needs of hospice care for health providers in Shanghai was developed. From November to December 2019,a questionnaire survey on the training needs of hospice care was conducted among 7 074 health providers in 223 medical institutions in Shanghai.Results:A total of 7 027 valid questionnaires were recovered, with an effective recovery rate of 99.3%. The training needs of health providers in Shanghai exceeded 71.0% for all items,with the average score of (2.58±0.63). The degree of training needs in each dimension ranges from high to low were knowledge(2.59±0.64), action(2.57±0.68) and motion(2.56±0.70). The top three training needs were“living will and law”(80.5%,5 660/7 027),“social work methods for hospice care”(75.3%, 5 290/7 027)and“stress and adaption in hospice care services”(75.1%,5 279/7 027). Female health providers(2.61±0.62), administrators, medical personnel and other post workers(2.68±0.56),those with junior professional title(2.61±0.62), with no witness of dying process(2.65±0.58),and those without participating in hospice care service(2.68±0.55)had higher training needs( P<0.05). Conclusion:The training needs of hospice care for health providers are very high in all hospitals. It is suggested to conduct stratified and targeted training for health providers in different positions and institutions according to the different training needs of hospice care.

Aim To study the protective effects of Rhynchophyll a of total alkaloids ( RTA ) on cerebral ischemia/reperfusion injury and the possi ble mechanism of action. Methods The effects of RTA on decapit ated gasping model and model of middle cerebral artery ischemia 2 h/reperfusion 22 h were observed. The neurological scores, cerebral infarct volume and cerebr al water content after ischemia/reperfusion were observed in rats respectively. The activities of NOS and SOD and the content of MDA in rat's brain tissue were measured. Neuron apoptosis in ischemia penumbral area were detected by terminal depoxynucleotidyl transferase mediated dUTP-biotin nick end labeling ( TUNEL ) . Results The average gasping times in mice treated with RTA 50 , 75 mg?kg -1 was significantly prolonged. The cerebral infarct volume and cerebral water content in rats treated with RTA 40, 60 mg?kg -1 were sign ificantly decreased in ischemic rats. RTA 40, 60 mg?kg -1 increased the ac tivity of SOD ,and decreased the activity of NOS and the content of MDA in the i schemic brains of rats. The number of apoptotic neurons in ischemia penumbral ar ea of cerebral tissue of rats treated with RTA 40, 60 mg?kg -1 was signif icantly lower than that in control rats. Conclusions RTA has pr otective effect on cerebral ischemia/reperfusion injury; this may be related to inhibit the activity of NOS and lipoperoxidation, and increasing the activity of SOD and decreasing neuron apoptosis.